Update on diabetes remission
Another useful and important new series on the special topics for our global and especially South Asian audience….Dr Leeds in conversation with Professor Mike Lean, University of Glasgow
In this interview, Professor Lean and Dr Leeds review the background and the evidence that shows how type 2 diabetes remission can be achieved. Prof Lean begins by explaining what is meant by diabetes remission. The ‘DiRECT’ diabetes remission trial that was run in Scotland and northern England by teams lead by Prof Lean in Glasgow and Prof Roy Taylor in Newcastle is then described. In the DiRECT trial he showed how people, with a diagnosis of diabetes within the last six years, had a high chance of remission if they lost enough weight (10-15kg). He described how this was achieved using a specially formulated total diet replacement (TDR) program with support from health care professionals (dietitians and practice nurses) followed by a step-wise reintroduction of conventional food and a well-managed weight maintenance program afterwards.
The evidence from several trials undertaken in the UK, in the middle East and in Glasgow on people from South Asia provides a solid foundation for changing type 2 diabetes management. Prof Lean believes that the time is right to now introduce weight loss as the first step in the management of type 2 diabetes not just in those who are overweight and obese, but also for those who may be within the ‘normal’ weight range but in whom, as shown in a study from Roy Taylor in Newcastle, weight loss reduces their excessive liver and pancreatic fat thereby improving their metabolic state, and leading to remission of diabetes in some participants.
Professor Lean has also driven the process whereby published guidelines on diet for type 2 diabetes for Europe emphasize the need for weight loss and state that the most effective way to achieve the needed 10-15kg weight loss is to use a formula total diet replacement (soups and shakes 800kcal/d diet) but Prof Lean points out that achieving that weight loss by any means can be effective too. Low and middle-income countries may struggle to formula diet programmes and Prof Lean is working on diets composed of traditional foods. Results from a study done in Nepal are expected shortly.
Viewers and readers who are concerned about their family history of diabetes and their rising body weight can check their risk on-line by using risk calculators (see links below). Those at high or intermediate risk are advised to consult a doctor, specialist nurse or specialist medical assistant to ask for a blood test and discuss their concerns.
Web-links to useful sources of information are given below.
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Diabetes remission:
Type 2 Diabetes Remission
Research Spotlight Low Calorie Diet
Diet-and-exercise-treatment-reverses-diabetes-61-percent-patients
Lose-the-weight-and-the-diabetes-healthcare-groups-latest-battle-plan-in-war-against-disease
Long term (5 year) results of Diabetes remission trial:
Weight-loss-can-put-type-2-diabetes-remission-least-five-years-reveal-latest-findings
A recent on-line seminar by Professor Lean: Weight management for diabetes remission of type 2 diabetes: DiRECT and subsequent trials; Video Link.
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Diabetes prevention:
International Diabetes Federation:
Type 2 Diabetes Risk Assessment;
South Asia:
The Indian Diabetes risk score:
East Asia:
Diabetes Hong Kong
Are you at high risk of diabetes?
Chinese language online risk calculator: Go to:
Sunway Medical – Malaysia – Know your risk – and choose Chinese language
South-East Asia:
Europe/Middle East and North America:
The Canadian Diabetes Risk calculator:
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